SERUM LEVELS OF ADHESION MOLECULES AND THROMBOMODULIN AS INDICATORS OF VASCULAR INJURY IN SEVERE PLASMODIUM-FALCIPARUM MALARIA

Severe Plasmodium falciparum malaria is characterized by multiple orga n involvment due to sequestration of infected erythrocytes in small ve ssels. Endothelial cell adhesion molecules play an important role in t his interaction. During the course of a severe cerebral P. falciparum malaria infection we found very markedly elevated levels of the solubl e adhesion molecules intercellular adhesion molecule-1, E-selectin, an d vascular cell adhesion molecule-1, with a maximum increase of nine, seven, and eight times, respectively. These very high levels of solubl e adhesion molecules point to an endothelial cell injury as an additio nal cause to physiological release or shedding due to receptor interac tions. Soluble thrombomodulin (sTM) levels showed an extremely marked elevation up to 332 ng/ml (up to 13 times the normal value) as well. M alaria patients without severe organ involvement/cerebral manifestatio n showed only a mild elevation of sTM levels. TM is a parameter indepe ndent of the immunological system. It is regarded as a marker of vascu litis and endothelial cell destruction. Therefore, markedly elevated s TM levels document a substantial endothelial cell injury in severe mal arial infection and may be of diagnostic and prognostic importance.